Ethics

J. Freeman Burket.

A widely accepted opinion among scholars of to-day that "the present man is a being that can be understood only through a knowledge of his past history." According to this theory, to understand man in his present ethical relations it is necessary to know historically the development of ethical thought.

Modern ethics is drawn from European ethical thought, which, in turn, comes from the Greek. Greek ethical speculative thought may be traced to where it is but dimly discerned in the utterance of wise precepts for conduct, in the literature of the sixth century before Christ.

What might be termed a vague semblance of a system of ethics may be found in the fragmentary treatise of Democritus, a contemporary of Socrates in the fifth century BC. This shows that the pre-Socratic thinkers had brought philosophical thought to a Socratic atmosphere. The times were ripe for the change, and the genius of Socrates appeared to perfect it. In him we first find philosophy clearly concerning itself with human conduct, and so forming that spring whence flowed onward the current of Greek ethical thought.

But up to this time the term ethics had not been applied to this new branch of philosophy. It was first given to a treatise of Aristotle in the following century. The word ethics admits of no clear comprehensive definition, as it is the subject to change in its application according to the development of thought. Even this first treatise to which it was applied broadened beyond the original meaning of the word, "that which relates to character," and embraced the good and bad qualities of character.

Greek ethics aimed at the perfection of the individual, not the good of society or the state. This perfection was to be attained through the individual's knowledge of what was for his highest good and the practice of it.

Comparing the Greek with modern ethics, we note a great change. This change, aside from the slight effect in this direction to the Stoics may have had upon Greek philosophy, is due almost wholly to Christianity and the revival of the study of Roman law. Christianity recognized a divine legislation as a guide for human conduct. This was the first step in the transition. More powerfully still did it operate in changing the aim of ethics from the perfection of the individual to the well-being of the many, of humanity. The great Teacher of Galilee sounded the keynote of this change in the utterance, "He that loseth his life shall save it." The utterance was profoundly emphasized when, in example, He gave his life for humanity.

The earnest revival of the study of Roman law in the twelfth century gave a new element to ethics, -natural law. Scholasticism, which dominated in European philosophy at that time, recognized two elements in the moral code, -the one Christian, dependent upon revelation; the other natural, perceived by natural reason and binding alike upon all men, Christian or not. Kent defines this natural law as consisting of "those fit and just rules of conduct which the Creator has prescribed to man, as a dependent and social being, and which are to be ascertained from the deductions of right reason." Modern independent ethical thought has its starting point in this century in the system of Thomas Aquinas. His was the genius that united those theological conceptions with the "abstract theory of the later Roman law," and so gave that start along which line modern ethical thought has advanced.

In his system, under general law, Aquinas distinguishes four different kinds: the Eternal law, Natural law, Human law, and Divine law. It is with natural law and human law that we are interested in this investigation. He teaches that natural law, which has already been defined, is that part of the eternal law that relates to rational creatures as such, and that human law "consists of more particular deductions from natural law adapted to the circumstances of particular societies."

He further teaches that "God has firmly implanted in the human mind a knowledge of the immutable, general principles of natural law, although the applications of them may be sometimes obscured and perverted by bad education and custom; and that human law is required not merely to determine the details for which natural law gives no clear guidance, but also to supply the force necessary for practically securing among imperfect men the observance of the most necessary rules for mutual behavior."

Here, then, we think we find the origin of class ethics, and, if so, the codes that govern societies. A code of ethics governing or regulating the professional conduct of members of a society has not been constructed on unhistoric ground, but as the result of the consensus of the philosophical thought of the ages. Should we abrogate the dental code, we would fall back again from modern ethics to the Greek, depending upon the perfection of the individual and setting aside the philosophical progress of these intervening centuries. It may be, as Dr. Ottolengui says, that, as dentists, we have aped the medical profession. That is but natural, as it is the one to which we are most nearly related. We all know, and it has been forcibly demonstrated to us in the recent investigations of hypnotic phenomena, that we are creatures of suggestion. What could be more suggestive than the medical code? Grant that the medical code has had an humble, even unworthy direct origin. Here, too, comes in suggestion. It must be borne in mind that man is continually building on to something, instead of starting out anew.

That the medical profession, in adopting as a guide the set of rules which Dr. Percival had formulated for his son, failed to deduce from it a code worthy of their profession, is perhaps true. That the dental profession, in imitating the medical, were not comprehensive-minded enough to develop it into a code that would protect and perhaps guide the professional man and hold in check the unprofessional one, is to be lamented. Still all these things argue, not the abrogation of a code, but the need of a better one.

Now that the subject, in the last few years, is being agitated, we believe the better code will be forthcoming. Since we have the defects of the old one to admonish, and added experience to enlighten , may we not hope for a code that will measure up to the standard of our present conception of the relationships and duties of professional life, and secure to each member that freedom which is on of the prime functions of a code? When that eminent physician of Brooklyn, Dr. Pilcher, intimates that a code of ethics interferes with his freedom, he certainly has not a true conception of ethics or the real aim of a code. It is through the idea of freedom that ethics is more closely connected with jurisprudence; for it is the "fundamental aim of jurisprudence to realize external freedom by removing the hindrances imposed on each one's free action through the interference of others' wills." He further says, "A set of rules is a mark of dependence," and we answer, Man is a dependent social being, and as such, to be a member of a society that has a code embodying rules of conduct in harmony with the correct notion of professional life, does not lower his dignity.

But should the better code that we anticipate be adopted, there still remains a serious aspect to this question. That the spirit of an ethical law shall be lived up to, requires men of ethical character. The law should not be depended upon to build character. That is not its prime function. Whence, then, must we look for that elevation of character of the individual members of the profession that will bring about a voluntary obedience to the spirit of a code of ethics? To the colleges? As it is through them our ranks are recruited, they would seem to be the Mecca of our hopes. In this paper we are considering character in the sense of development, not in the sense of inherited qualities. We realize that it is far easier to criticise institutions than it is to make them more proficient; however, honest consideration of facts is always fair. Is a course of three years of six or nine months each sufficient to give a student a liberal education, the principles and training of dentistry, and a good moral character? It might impart the second, if the first and last were possessed to a good degree. Yet we have in mind a graduate of this spring, who, when he entered the dental college three years ago, had not even a common school education. It was not for lack of opportunity, either. Good schools had been continually within his reach; but he was an idle, dissipated youth, wanting in the elements of good character. At the end of three years, however, he has come out of college a DDS. Now, if the standard of Greek ethics prevailed to-day, and the good of the individual alone was to be considered, then, if receiving and graduating this young man improved him in any degree, the college would have been doing its duty; but in the light of modern ethics, when the good of the profession, the well being of humanity, are the first aim, what of such a course? What must become the ethical character of a profession recruited with such men? This may be an extreme case, we admit, but we know of its parallel. If these extreme cases are allowed, even now and then, how many must be the intermediate ones between them and a proper standard of education and character? The student, or his parents, perhaps, paid his matriculation fee, tuition, etc. We mean no reflection. That old adage, "Money is the root of all evil," may still hold good occasionally. It would seem ,and we really think it would be, unjust to inform a student, after he had been in college three years and paid out his money, that he was unfit to become a member of the profession he had chosen. The mistake in such a case lies at the other end of the course. The means of a good high-school education are within the reach of every youth who has the mental and physical ability to become a dentist, and have been for the last twenty years. We must remember that society ever measures up to the demands made upon it.

What, then, is the standard of manhood to-day? Character. A development not of the intellect alone, but of the soul. What, then, according to the thought and spirit of the times, may the professional colleges demand of the students who seek entrance to their halls? Nobility of character. We do not undervalue the influence of the colleges in the development of character, but we must bear in mind that the student has nearly passed through what is considered the formative period of life before coming under their influence.

It is, then, in this demand, on the part of the colleges, for nobility of character in matriculants that we must look for the ethical standard of the profession. For-we repeat the statement-society ever measures up to the demands made upon it. It is the back of the colleges, to home and youthful environment, that we must look for good moral character, which with culture makes the modern gentleman. In the home and in society, what are the signs of the times? Here, too, we find the effects of the philosophical thought of the age. Never before, it is believed, have mothers been so awakened to their duty and power as character-builders in the home.

But what of the children outside of beneficient home influence? Organized society is at work there. All movements, from the kindergarten to the society that goes out to save the debauched man or woman from the gutter, show the tendency of the age to characterbuilding. The statement so frequently quoted, "To make the world better we must educate," should be changed to denote a broader development. To make the world better we must develop man's threefold nature, -physical, intellectual, and spiritual. It further shows the harmony of the efforts of society with the ethical thought of the time. In these movements for the bettering of humanity, the individual unconsciously attains for himself the highest good, -the aim of Greek ethics, -while with conscious effort he seeks the aim of modern ethics, -the well-being of humanity. The forces at work in society indicate with unerring certainty that there will be an abundance of ethical character with which to replenish our professional colleges. The only question is, Will they demand it and accept none other? If the do well this their duty, society will meet their demands.

Though we would be optimistic, we would also be consistent. While good is steadily and surely marching on to its highest consummation, evil is stalking ever at its side. Despite all humane efforts, the degradation of childhood, youth, and manhood is startling to contemplate. He who would be wise must bear this fact in mind. The good must still be protected and the bad restrained; hence the need of a code. The future, we predict, is not one of perfection, but one of happy enlightenment; when man from his infancy will be brought up in that rational manner that he shall be able to realize the relationships of life and the duties arising therefrom; when, as a result, selfishness, that relic of barbarism that seeks individual good alone, will have been displaced by that nobler quality of the human heart that seeks the well-being of others. It is such an ethical development the present promises for the future.

DISCUSSION

Dr. B. Holly Smith. I hold in my hand a copy of what is purported to be about the first code of ethics prepared for any dental association. In the preface of this code the remark is made that this code of ethics is taken from the code of ethics of the American Medical Association - 1847. We are satisfied to trace our code of ethics to a medical association. The priests in ancient times were the repositories of all knowledge, and I believe that it originated with them in some fraternal feeling, and that the development of the present code under which we practice may have resulted from some such origin. Ethics deals with that which is due by one man to another. It is the science of right conduct and character, which treads the natural ground or moral obligation, and the rules which determine the conduct of one person with respect to himself and the rights of others, -the science of an ideal humanity.

I believe that no man who writes a paper on such a subject would feel that he had discharged his whole duty to the profession if he did not call up before him, and administer, in the presence of the association, a full and drastic dose to the colleges. I believe that that is commonly expected. I am sure that no one will dispute that the obligation of the colleges to the profession is a very serious one; that as teachers, we are to prepare young men not only to practice their profession, but to associate with their brethren in a simple and becoming manner; and I am fully in accord with the gentleman when he says that some ethical training should be sought and secured from the colleges. I would like to see, as a teacher, the state of affairs recommended by the National Association of Dental Faculties, that every man who receives a diploma from a dental college should be required to subscribe to a code of ethics. I would like to see it arranged so that his violation of that code would abrogate his rights to practice under that diploma. I don't know how practical this suggestion is. That suggestion was made by the essayist, and I am willing to place the ground as high as we can possibly occupy it. If such an understanding were had with the students who graduate from our colleges, I believe that in moments of disappointment, in the moments of waiting, when the young man thinks, Hadn't I better turn quack and advertise for patients? I believe that such an act on his part- subscribing to a code of ethics-would strengthen him and enable him to hold out until, through his society and his confreres, he could respectably, in due course of time, build up a dental practice. While we look to the colleges for some ethical training, I do not agree with the essayist that we could exact of the colleges a moral standard of character from its students. The college is in no wise responsible for the morals of those who attend its lectures, and it can not be held so. It is true that there should be, on the part of its corps of professors and teachers, the high moral obligation to, by personal bearing, conduct, and example, a gentlemanly life and behavior. Further than that I think we cannot exact of the faculties or of the colleges.

It has struck me that there is some room for improvement among our associates and among ourselves as dentist, in the line of our relations with our patients, our acceptation of what they say, and our reliance in the credibility of any report they may give in reference to our brother practitioners. We have also a right to exact from the journals the same respect that we exact from our associates; and the day is past when a man can come into a dental association with all his patent-medicine bluff and bravado and push his wares and ideas through a scientific organization.

Dr.Maxfield. I believe that the future of our profession depends upon ethics. That point was brought out in the discussion of the paper of my friend from Chicago, in the reference to an article by Professor Miller, in which he says that the kind of treatment given his patients depends upon the size of their pocket-books. Now, I ask you if that is good professional ethics. If that is not trade, what is trade? I cannot outline any method of procedure for the future, only that which stands on the code of ethics, the only true Christian code, that a man must do what he can for his brother. I know it is a hard thing, I know it by practical experience, to sit still hour after hour and day after day, not seeing a patient, and at the same time seeing your advertising competitor thronged. I know what it is to see an advertisement in the paper, and to know you cannot say anything to the public in answer to it; first, because if you do answer it the public will say you are jealous. So you cannot give the truth to the public. Now, we must educate our members, we must educate the young men who come into the profession as to what it is to be a professional man; that we are not working for dollars and cents alone; that while the work done is worthy of its price, yet the price should not be first.

Our colleges have got to be more particular in regard to the young men they are taking in.

Dr. William H. Trueman. My brother here made the remark that we are working for dollars and cents. I should like to know why we should not. It seems to me that this idea that there is a difference between a professional man and a business man is mere theory, and cannot be borne out in practice. I would like to ask what it is that an honest upright business man may do that a professional man cannot do? What can I do as a business man that I cannot do as a professional man, and what can I do as a professional man that I cannot do as a business man? I consider myself a professional man, but I consider myself a business man also, and I am very sorry indeed that I am not a better business man than I am. If every professional man were a business man there would not be so many of those sad cases where, after a long a brilliant professional career, as age advances and they lose their grip (as lose it we will, if we live long enough), the outlook reveals nothing but poverty and the grave. I have seen many such cases; some are very, very sad. How much better it would have been for them, their families, the profession, and the communities in which they lived had they been better business men, and had paid more attention to that important matter of dollars and cents. Exception was taken to Professor Miller's remark about the difference in his services to different patients. I think Professor Miller is right in that. He recognizes, as every thinking man must do, that the poor have claims upon the services of our profession as well as the wealthy; he recognizes also that people of limited means are far more numerous than those who are able to pay liberal fees. Now, in what other ways can this condition be met? I would ask the gentleman who made that remark, What would he do? What would he advise others to do when a man earning six to twelve dollars a week, out of which he had himself and a family to keep, applied for relief from an aching tooth? Would he curtly tell him, simply because he was poor, that he had better have it out; or would he take from him a month's wages, treat and fill it for him in the highest style of the art; or would he do as Professor Miller suggests, and by a more simple and less expensive service do for that tooth the best that could be done for a fee its owner was able to pay? What does the code of ethics suggest upon that point? There are vastly more poor people, and people of moderate means, than people of wealth in every community, and if you will take the trouble to examine into the matter, you will find that those poor people need a dentist's services quite as much, if not more, than do their more wealthy neighbors. Is it a violation of the code of ethics to endeavor to adapt our methods to meet their needs? If so, why?

Professor Miller recommends one treatment for those who are willing and able to pay, and another for those who are not. Do not physicians do so? The millionaire's wife comes in suffering from say, nervous prostration, and they say to her, The best thing you can do is cross the water and spend six months in Italy or Southern France; and probably that is the very best thing she could do. But is that their advice to the mechanic's wife? They have to advise the mechanic's wife differently. A man must adapt his treatment to suit his patient's means. Now, I would like to ask in what way, manner, for, or shape, does this violate the code of ethics.

It seems that we cannot get along without hitting a blow at the colleges. I have no patience with it. I believe that our advancement as a profession is to a very great extent due to the colleges. I think they are doing a manly work. If there are any men in the profession who are making sacrifices to advance the profession, it is the men who are teachers in the colleges. Have we seconded their efforts? Where are our libraries? Where can I go for information if I want to study any professional subject, or to examine dental books that I do not own? Why is it that there are no adequate means in our own profession for studying the science of dentistry? Simply because the rank and file of the dental profession have not done their duty in following up the work of the colleges. The college simply gives its students the beginning of an education; they cannot say what the end shall be. You cannot say that of your children, whose characters you are supposed to mold from birth to maturity. I know it is said, "Train up a child in the way he should go, and when he is old he will not depart from it"; but somehow a good many sons and daughters get into wrong ways before they get old. Is that always their parents' fault?

Dr. Maxfield. Mr. President, I don't think the gentleman who has just spoken quite understood the ground I took in reference to business and professional ways. When a patient comes into your office and you size him up to see how much you can get out of him, that is business; when you examine the case to see what you can do for you man to help him, that is professional. That is the difference. I did not mean to give a drastic dose to our colleges, I did not intend it; but we all know that a great many incompetent men have been graduated from the dental colleges. I know how honest the dental colleges are, but I know that if we want them to be on a higher level we have got to bring the profession up to that high level, and then the colleges will be there with us.